Increased activity of prothrombin complex factors. Prothrombin on quick is increased what does it mean. Interpretation of study results

An analysis for prothrombin is part of a blood coagulation study - a coagulogram. In addition to the activity of this protein, indicators such as PI are also determined ( prothrombin index, or PTI) and PT (prothrombin time) to assess the rate of clotting. The normal values ​​of prothrombin in women, men and children, as well as the reasons for their deviation from the norm, are described in detail below.

Prothrombin - what is it?

Prothrombin is a high molecular weight protein compound involved in blood coagulation. Its production occurs in the liver in the presence of many substances. In particular, vitamin K, the deficiency of which leads to the synthesis of incorrect prothrombin molecules - they form blood clots that disrupt blood flow and can be fatal.

An analysis of prothrombin is needed to assess blood clotting, and the most accurate and versatile research method is PC - Quick prothrombin. What it is? This test detects the activity of prothrombin in the patient's blood compared to that in a control portion of plasma. This is the ratio of the clotting time of the patient's plasma to the time of this process in the sample.

The analysis is named after the scientist A. Quick, who proposed this method. In the test results, prothrombin according to Quick is expressed as a percentage. In the international nomenclature, it is assigned number II, since it was the second discovered after fibrinogen.

Quick analysis is used not only to assess the activity of blood coagulation elements, but also to study the functioning gastrointestinal tract and liver. The PC test is more versatile than the prothrombin time and prothrombin index tests.

List of indications for the analysis of prothrombin according to Quick:

• impaired blood clotting;
• liver disease;
• antiphospholipid syndrome - increased thrombus formation due to autoimmune causes;
• blood cancer;
• pathologies in which the production of vitamin K is impaired (blockage biliary tract, poor digestibility of food in the intestines, etc.).

Reference: Vitamin K is produced by bacteria in the intestine and is actively involved in the formation of prothrombin. The rate of blood clotting is negatively affected by both its lack and excess.

The PC test is necessary to control the hemocoagulation system during the period of use of anticoagulants - Heparin, Warfarin and others. The structure of the blood and its composition also change with the onset of menopause in women (after 45 years), which is a risk factor for the development cancer. Therefore, at this age, it is especially important to regularly take an analysis for prothrombin.

Prothrombin time - what is it?

Depending on the causes of bleeding, blood can begin to clot in two ways - internal or external. The first is activated if the vessels are damaged from the outside - as a result of a bruise, cut, scratch, bite, abrasion. The internal path works when the integrity of the wall blood vessel was broken from the inside - under the influence of toxins, pathogenic microorganisms, antibodies.

Prothrombin time is an indicator that reflects the work of the internal pathway in the hemocoagulation system.

It reflects the effectiveness of the "repair" of vessels that have been damaged by compounds circulating in the bloodstream. In the results of the analysis, the prothrombin time may be referred to as PT, ecombipl RT or RT.

Prothrombin time is increased, compared with the norm, under the following conditions:

• lack of vitamin K;
• the initial stage of DIC;
• liver pathologies;
• taking drugs from the group of anticoagulants - Tromboass, Agregal, Warfarin, Heparin and others;
• hemorrhagic diathesis of newborns;
• inflammation and blockage of the biliary tract;
• Zollinger-Ellison syndrome;
• malabsorption of fats in the intestine;
• deficiency of coagulation factors - prothrombin, AC-globulin, proconvertin and Stuart-Prauer factor.

The lower the concentration of prothrombin in the blood, the higher the prothrombin time, because the process of blood clotting is slower.

prothrombin time is decreased if the following conditions exist:

• pregnancy;
• DIC;
• high levels of antithrombin-III and other anticoagulants produced by the body;
• deviation from the norm of hematocrit - the ratio of the volume of blood cells to the volume of plasma.

Low prothrombin time during the test may be due to long-term storage plasma before the study and violations when taking blood.

The prothrombin index is an indicator that reflects the rate of start of blood coagulation by inner path. It is calculated on the basis of prothrombin time, so its increase is observed with the same disorders in the body as an increase in PT, as well as a decrease.

To determine the PTI, the patient's plasma clotting time is divided by this value in the control sample. Normally, the result should be 95-105%.

The accuracy of the analysis for the prothrombin index depends on the sensitivity of the drugs used in the laboratory. Therefore, it cannot be called universal, in contrast to the Quick prothrombin test.

Elevated prothrombin

If the Quick prothrombin test is elevated and shows high values ​​​​(up to 150% or more), the reason for this may be:

• DIC syndrome;
• cholestasis and other diseases that reduce the activity of vitamin K;
• diseases that disrupt the functioning of fibrin;
• hereditary and acquired pathologies leading to a deficiency of coagulation factors (, liver disease, nephrotic syndrome).

Elevated prothrombin also appears with long-term use drugs:

• antibiotics;
• diuretics;
• aspirin;
• indirect anticoagulants;
• anabolics;
• Methotrexate;
• laxatives;
• nicotinic acid;
• Heparin and other clotting inhibitors.

Prothrombin rate, table

The extreme values ​​of the PC are the numbers below 78 and above 142%. The rates of prothrombin according to Quick are presented in the table.

The norms of prothrombin in men and women of the same age group do not differ. Normal prothrombin time for both sexes is 9-12 sec. The rate of prothrombin in the blood of women who are expecting a baby is slightly higher than normal values.

Low prothrombin

Low prothrombin according to Quick always indicates an excessively rapid formation of blood clots and can be triggered by conditions such as:

• pregnancy and the period after childbirth;
• vein thrombosis;
• penetration of thromboplastin into the vessels due to tissue damage;
• high blood viscosity (polycythemia).

The decrease in PC can be explained by such a dependence - the activity of the prothrombin protein is high, the blood coagulates faster compared to the control plasma sample, therefore the Quick prothrombin test is below normal.

Low prothrombin according to Quick can also be caused by taking Mercaptopurine, hormonal contraceptives and other drugs that increase blood density.

prothrombin during pregnancy

Coagulogram - obligatory part tests for pregnant women. The evaluation of this study, including prothrombin tests, allows timely detection of conditions dangerous to the health of the child and the expectant mother.

Prothrombin according to Quick during pregnancy is normally slightly lowered, that is, the activity of the coagulation system increases. This is due to the emergence of a new circle of blood circulation and the preparation of the body for the upcoming birth and possible blood loss.

A very low PC can provoke the development of thrombosis, and its increase in pregnant women can cause severe bleeding during childbirth, including internal bleeding.

Severe bleeding can cause hemolytic shock due to mixing of mother's and baby's blood. This is one of common causes postpartum mortality. To avoid this, in this situation, not only monitor and control the state of the coagulation system, but also introduce immunoglobulins at the 28th week of pregnancy that destroy potentially dangerous antibodies.

• The norm of the prothrombin index for women carrying a child is 80-100%. When it high values in order to avoid thrombosis and other complications, drugs are indicated that reduce the increased activity of coagulation.
• Low PI, on the contrary, carries the risk of bleeding. Normal value prothrombin time for pregnant women - 11-18 sec. During pregnancy, any deviation from the norm in the coagulogram is a reason for a thorough examination and, in most cases, hospitalization.

prothrombin test(PV, % according to Quick, INR / INR)

Warfarin blocks the synthesis of vitamin K-dependent blood clotting factors in the liver, namely factors II, VII, IX and X. The concentration of these components in the blood decreases, the clotting process slows down. The optimal anticoagulant effect is observed on the 3rd - 5th day from the start of the drug. The action of warfarin stops 3-5 days after the last dose. The drug is almost completely absorbed from the gastrointestinal tract. During the period of taking oral anticoagulants, INR (INR) should be monitored every 3 days. After stable achievement of the recommended therapeutic level of INR, they switch to 1 time per month. The frequency of INR determinations should be increased with the introduction of new medicines, which could affect the effectiveness of anticoagulation, changes in clinical picture, switching to a new batch of the drug. Critical values ​​of INR (INR) >

Description:

Prothrombin is a protein, one of critical factors blood coagulation system (factor II), a thrombin precursor that stimulates the conversion of fibrinogen to fibrin. Prothrombin is synthesized in the liver with the participation of vitamin K, so liver diseases that lead to impaired protein-synthesizing function and the gastrointestinal tract (primarily the intestines), leading to impaired vitamin K synthesis, affect the results of the prothrombin test.

The prothrombin test is a screening laboratory test that mimics the external pathway of blood coagulation: this is the clotting time of recalcified plasma after the addition of tissue thromboplastin of a certain sensitivity to a deficiency of prothrombin complex factors (factors V, VII, X and prothrombin itself - factor II) and Ca ions. The test is used to assess the presence of a deficiency of prothrombin complex factors and external path clotting or coagulation inhibitors, monitoring the intake of indirect anticoagulants and as an additional test for assessing the protein-synthesizing function of the liver.
The results of the prothrombin test can be presented in different form. In ML "Synevo" the results are issued in the following forms:

• The prothrombin time (PT), in seconds, reflects the clotting time of plasma after the addition of a thromboplastin-calcium mixture. It depends on the activity of the thromboplastin used, therefore it is incorrect to compare the absolute values ​​obtained in different laboratories.
• % prothrombin according to Quick. In 1935, A. Quik proposed to evaluate the activity of prothrombin as a percentage: the patient's PV is compared with the calibration curve of the PV of the control plasma. The principle of constructing this calibration graph is the dependence of PT on the % content of prothrombin complex factors. That's why given form issuance of prothrombin time is expressed in%. To date, this form is recognized in the world, is more standardized than the prothrombin index, has a higher diagnostic sensitivity to a deficiency of factors in the area low values. It should be borne in mind that a direct correlation between the results of the prothrombin index and the % of prothrombin according to Quick will be observed only in the region of normal values: as the activity of the prothrombin complex decreases, an increasing difference will be noted. ML "Synevo" does not determine the prothrombin index (the ratio of the clotting time of the control plasma to the clotting time of the patient's plasma, expressed in%), because this indicator does not reflect the sensitivity of the thromboplastin used, does not coincide with the Quick % values, especially in the area of ​​low values, which are most critical for clinical practice, does not allow comparison of the results made in different time even in one laboratory, because does not take into account the sensitivity of thromboplastin.
• INR (International Normalized Ratio), Latin abbreviation INR (International Normalized Ratio) is a standardized way to present the results of a prothrombin test, specially developed and recommended for monitoring therapy with indirect anticoagulants by a committee of experts from WHO, the International Committee for the Study of Thrombosis and Hemostasis and the International Committee for Standardization in hematology.

INR is calculated by the formula:

INR (INR) = (Patient Prothrombin Time / Normal Mean Prothrombin Time) x ISI,
where ISI (International Sensitivity Index of thromboplastin), aka MIC (International Sensitivity Index) is an indicator of the sensitivity of the thromboplastin used, standardizing it relative to international standard. The ISI values ​​of used thromboplastins around the world range between 1 and 3, and are set by the test system manufacturers for each batch of reagents. Thromboplastins are used in Synevo ML high sensitivity(MIC about 1.0).

INR is a mathematical correction by which the prothrombin time is standardized, measured using various thromboplastins with different sensitivities. The optimal INR limits to be achieved during treatment with indirect anticoagulants depend on the therapeutic goals and are determined by the attending physician. INR (INR) = 2.0-3.0 observed in most clinical cases(primary and secondary prevention thrombosis, prevention of systemic embolism in patients with atrial fibrillation and etc.).

INR (INR) = 2.5 - 3.5 are observed with recurrent deep vein thrombosis (two or more cases), recurrent systemic embolism, installed mechanical heart valves, etc.

Warfarin blocks the synthesis of vitamin K-dependent blood clotting factors in the liver, namely factors II, VII, IX and X. The concentration of these components in the blood decreases, the clotting process slows down. The optimal anticoagulant effect is observed on the 3rd - 5th day from the start of the drug. The action of warfarin stops 3-5 days after the last dose. The drug is almost completely absorbed from the gastrointestinal tract. During the period of taking oral anticoagulants, INR (INR) should be monitored every 3 days. After stable achievement of the recommended therapeutic level of INR, they switch to 1 time per month. The frequency of INR determinations should be increased with the introduction of new drugs that could affect the effectiveness of anticoagulation, changes in the clinical picture, and the transition to a new batch of the drug. Critical INR values ​​(INR) > 6.0 is the risk of bleeding, especially in patients with gastrointestinal diseases, arterial hypertension, kidney diseases, cerebrovascular diseases, etc. It must be taken into account that taking indirect anticoagulants can cause the so-called "warfarin skin necrosis" - a complication due to the presence of protein C deficiency in the patient, therefore, this pathology must be excluded before starting therapy.

INR and % prothrombin according to Quick correlate negatively - a decrease in prothrombin according to Quick corresponds to an increase in INR and a prolongation of prothrombin time. An increase in prothrombin time indicates hypocoagulation, a decrease indicates hypercoagulation.

Prothrombin test does not reflect deficiency factors VIII, IX, XI, XII and XIII, little depends on the use of heparin (in therapeutic dosages).

How to prepare for the analysis:

Blood analysis

To exclude factors that may influence the results of the study, it is necessary to adhere to the following rules preparation:

• blood for research is given only on an empty stomach!
• before surrender venous blood preferably 15 minutes rest;
• 12 hours before the study, you should exclude alcohol, smoking, eating, limit physical activity;
• exclude medication. If it is not possible to cancel the medication, the laboratory must be informed;
• children under 5 years old, before donating blood, be sure to drink boiled water (in portions, up to 150-200 ml, for 30 minutes)

Laboratory research is an important area of ​​diagnostic medicine. Various analyzes allow you to determine whether everything in the body is functioning normally, make it possible to timely recognize any violations in the activity of organs and systems, and even understand the cause of their occurrence. Today there are many varieties laboratory research and understand their diversity to an ordinary person happens to be difficult. And today we will consider what the analysis for prothrombin according to Quick is, what it is, we will answer the question, what is the norm this study, and what does it mean if this indicator is lowered or increased.

A blood test for prothrombin is one way to determine the ability of blood to clot. Complex analysis Physicians call this indicator a coagulogram.

What is a prothrombin analysis according to Quick?

In order to understand what such a study is, you first need to determine what prothrombin is. So, this term is called a special protein compound that takes part in the processes of blood clotting. Prothrombin is produced in our body by the liver with the participation of a number of substances, among which is vitamin K.

An analysis for prothrombin allows you to determine the level of blood clotting, and the Quick study is considered the most accurate and at the same time universal way diagnostics. When performing this test, laboratory technicians evaluate the activity of prothrombin in a blood sample taken from a patient, comparing it with the activity of this compound in a control sample.

The implementation of such a study allows you to determine not only the level of blood clotting, but also allows you to study the activity digestive tract as well as the liver. The result of the Quick analysis is expressed as a percentage.

When might such a study be required??

A blood test for prothrombin according to Quick is performed when:

Blood clotting disorders;
- ailments of the liver;
- antiphospholipid syndrome(for the diagnosis of increased thrombus formation, the cause of which is autoimmune disorders);
- blood oncology;
- violations of the synthesis of vitamin K.

Sometimes a Quick blood test is performed to control the coagulation system during the period when the patient consumes anticoagulant drugs, for example, Warfarin or Heparin, etc.

The norm of prothrombin according to Quick

Doctors assure that the extreme values ​​​​of this study should be considered the minimum figure of 78% and the maximum - 142%. There is also a gradation of the norm for different ages.

Yes, in childhood up to six years, an indicator of 80 - 100% is considered the norm.

For children from 6 to 12 years old - from 79 to 102%.
For teenagers from 12 to 18 years old - 78 - 110%.
For adults from 18 to 25 years old - 82 - 115%.
For adults from 25 to 45 years old - 78 - 135%.
For adults from 45 to 65 years old - from 78 to 142%.

Decrease in prothrombin

Decrease in the level of prothrombin in accordance with the results of the Quick study may indicate an excessively rapid formation of blood clots. This phenomenon can be explained by:

Pregnancy and the period after childbirth;
- vein thrombosis;
- penetration of thromboplastin into the vessels against the background of tissue damage;
- high viscosity blood (this condition is also classified as polycythemia);
- taking certain medications that increase blood density.

With a decrease in prothrombin according to Quick, the patient's blood coagulates faster than the control plasma sample.

What does an increase in the level of prothrombin according to Quick mean??

This phenomenon can be observed in a number of pathological conditions, namely when:

Congenital deficiency of certain clotting factors;
- deficiency of coagulation factors that arose against the background of liver ailments, as well as amyloidosis or nephrotic syndrome;
- deficiency of coagulation factors due to the presence of antibodies to such factors;
- decreased activity of vitamin K;
- DIC syndrome, which stands for disseminated intravascular coagulation;
- consumption of a number of medicines, represented by anticoagulants, clotting inhibitors, anabolic steroids, antibiotics, acetylsalicylic acid laxatives, methotrexate, nicotinic acid, diuretics;
- ailments of the functioning of fibrin.

With an increase in prothrombin above the norm, the patient's blood clotting occurs more slowly than in the control sample.

Features of the level of prothrombin according to Quick during pregnancy

When carrying a child, the level of prothrombin according to Quick naturally decreases somewhat, in other words, the coagulation system works more actively. This is due to the occurrence in female body a new circle of blood circulation and the gradual preparation of the body for childbirth and possible blood loss.

But at the same time, an excessive decrease in the level of prothrombin carries the threat of thrombosis, and a significant increase this indicator increases the likelihood heavy bleeding during childbirth (even internal). Therefore, the coagulogram as a whole and the level of prothrombin are important diagnostic studies during pregnancy.

In order for the study on the level of prothrombin to be really informative, it is important to adhere to elementary rules: stop eating fatty and fried foods the day before blood donation and do not eat at least six hours before the test.

Modern medicine operates with multiple diagnostic methods. And one of them is a blood test. Prothrombin according to Quick: what is it and why is it special this procedure- we will understand further.

Basic terminology and all the most important thing about this problem

It is important to note that this is a precursor to thrombin, the protein that is capable of forming blood clots. Protein is produced in the liver, and for this you need vitamin K.

When is a prothrombin test done?

• To assess liver function.
• To assess the functioning of the digestive system.
• And to determine the processes of blood clotting.

So, as a result of a study on prothrombin, doctors determine the prothrombin index, prothrombin time, INR (that is, the international ratio) and prothrombin according to Quick.

Quick prothrombin: norm and definition

Back in 1935, the scientist A. Quick proposed this analysis in order to determine blood clotting by the level of prothrombin in it. The results of the analysis show the percentage of active prothrombin in normal plasma solutions.

It should be noted that today it is one of the most popular analyzes for prothrombin. After all, it is effective, low-cost and gives the right results.

What are normal performance which indicate that everything is in order with the body? So, the numbers should be in the range from 78 to 142.

In what cases is it necessary to donate blood for prothrombin according to Quick

• At all sorts of violations related to blood clotting.
• If it is necessary to identify pathologies of the liver.
• To determine the deficiency in the body of vitamin K4.
• To control blood clotting while taking anticoagulants.

When scores go up

It happens that prothrombin according to Quick is increased. What could this mean? This is possible in the following situations:

1. While taking medications called anticoagulants. And also in the treatment of antibiotics and diuretics.
2. For problems such as oncological tumors, DIC, leukemia.
3. Also, indicators can be overestimated as a result of a lack of blood clotting, both acquired and congenital.

When rates can be lowered

If a we are talking about reduced rates, then this is primarily fraught with varying complexity bleeding. Other situations where a similar phenomenon can also be observed:

1. If the body lacks vitamin K, which improves blood clotting.
2. When using certain drugs that can affect blood clotting.
3. If there is a lack of certain factors in the blood (acquired or congenital).
4. If there are leaks in the liver pathological processes associated with clotting.

The blood coagulation system is one of the most important protective functions our body. AT normal conditions when nothing threatens the body, clotting and anti-clotting factors are in balance and the blood remains a liquid medium. But if a vessel is damaged, a whole cascade of reactions is immediately triggered, programmed for the formation of a blood clot and blockage of the damage.

What is a clotting system

The hemostasis system is very complex, involving many tissue and serum factors. Its launch really looks like a cascade: it is a chain of reactions, each subsequent link of which is accelerated by additional enzymes.

Simplified, the scheme of blood coagulation looks like this: thromboplastin is released from the damaged endothelium, with the participation of calcium ions and vitamin K, it activates prothrombin. Prothrombin is converted to active thrombin, which in turn triggers the formation of insoluble fibrin from soluble fibrinogen. This process is completed by the retraction stage. blood clot, that is, its compaction and proper blockage damage.

At each stage, many more factors are involved in this scheme. In total, they are isolated by 13 plasma and 22 platelet.

What is prothrombin

This is a glycoprotein produced in liver cells, plasma coagulation factor II.

For the synthesis of prothrombin, vitamin K is required, so one of the reasons for its decrease is an insufficient intake of this vitamin with food or low level its synthesis in the intestine.

Prothrombin is an inert protein, its activation occurs under the action of coagulation factor XII ( internal system) or with damage to the endothelium (external mechanism of hemostasis).

In practice, qualitative tests for prothrombin are used, which reflect its content in the blood only indirectly. They are based on calculating the period of time during which blood coagulates when thrombokinase activators are added to it (which in turn activates prothrombin, turning it into thrombin, and thrombin catalyzes the conversion of fibrinogen into fibrin).

Therefore, when we say “analysis for prothrombin”, “blood for prothrombin”, this does not mean determining its concentration in the blood, as, for example, glucose, hemoglobin or bilirubin are examined. And the result is given not in quantitative units, but as a percentage. This concept characterizes the external mechanism of hemocoagulation as a whole and reflects the activity of the entire prothrombin complex (factors II, V, VII, X).

How are prothrombin tests performed?

The essence of almost all methods for studying the activity of the prothrombin complex is the calculation of the time for the formation of a fibrin clot immediately after adding activators to the blood, as well as comparing this time with normal values.

Blood is drawn into a test tube with an anticoagulant (sodium citrate). A test tube with citrated blood is slightly heated in a water bath. A reagent consisting of thromboplastin and calcium chloride is added to it. The stopwatch measures the time for the fibrin fibers to fall out. This is prothrombin time (PT). Its normal value is 11-15 seconds.

Having determined the patient's PT, it is compared with the normal prothrombin time (PTT). It is usually indicated on the reagent bottle and depends on the activity of the thromboplastin used. Usually this figure is from 12 to 18 seconds (it may be different in each new reagent sample). The ratio of PVN to PV of the subject, expressed as a percentage, is the prothrombin index (PI). Its normal value is 80-105%. How more time blood coagulation (PV), the lower the PI, which will indicate hypocoagulation.

Prothrombin according to Quick

The test is also based on the ratio of normal prothrombin time to the patient's PT, expressed as a percentage. But the method is considered more accurate. For the study, several dilutions of plasma (1:2, 1:3,1:4) and the construction of a calibration graph are used. For each dilution, the PV is determined and plotted.

Prothrombin rates according to Quick are from 75% to 140%.

Within normal protein ranges, Quick and PTI results may be identical. At a low content, these indicators sometimes diverge.

Another indicator is INR (international normalized ratio). It is mainly used to evaluate the effectiveness of anticoagulants. This indicator is calculated by the formula:

INR \u003d (patient PV / average PV in the norm) * the value of the international thromboplastin sensitivity index (ISI).

This index is indicated on each reagent package. The INR allows you to standardize the results of PT and PTI performed in different laboratories. The INR value in healthy individuals is 0.8-1.2.

The numbers of prothrombin according to Quick and INR are inversely proportional to each other: if prothrombin according to Quick is increased, then INR is reduced and vice versa.

When is prothrombin tested?

A coagulation test (coagulogram) is not a routine examination, it is not prescribed to all patients in a row. The test is carried out in the following situations:

• The presence of symptoms that indicate problems with clotting: frequent nose and other bleeding, bruising without apparent reason, bleeding gums when brushing teeth, hemorrhagic rash on the skin.
• Thrombophlebitis of the veins of the lower extremities.
• Examination of the patient before any surgical interventions.
• Pregnant women are required to be examined.
• Control during treatment with anticoagulants. They are prescribed to patients with arrhythmias, after valve prosthetics, with thrombophlebitis. The goal of these drugs is to increase the clotting time while keeping it within a safe range. In this case, PV will be increased by 1.5-2 times, PTI and prothrombin according to Quick are reduced, INR is increased (safely up to 2-3).
• In diseases of the liver to clarify its functional insufficiency.
• Before the appointment of estrogen-containing hormones, as well as in the process of taking them.

Norms of prothrombin in various groups of patients

The norms of this glycoprotein in the blood are somewhat different in different age groups. In children under 18, its normal content ranges from 80 to 110%, in adults - from 78 to 145%.

Norms in adult men and women do not differ. A moderate increase in prothrombin may be in women before childbirth.

Prothrombin index

This indicator is determined in all coagulograms. What does prothrombin index mean?

The norm of the prothrombin index is 80-105%. The greater the patient's PV compared to the normal one, the lower his PI will be and vice versa. Accordingly, a low index indicates weak coagulability, and high index- about hypercoagulability (tendency to thrombosis).

An analysis for the prothrombin index is prescribed in the same situations as the analysis for prothrombin according to Quick. Basically, both of these values ​​are in direct correlation and in the range of normal content can be the same.

The norm of the prothrombin index during pregnancy varies somewhat by trimester:

• I trimester - 80-119%
• II - 85-120%
• III - 90-130%.

How to decipher a coagulogram

This analysis is carried out in order to get answers to the questions:

• whether the blood is clotting normally;
• whether there is a risk of postoperative or postpartum bleeding;
• what is the reason frequent bleeding and bruises;
• what dose of anticoagulants is safe if necessary.

Blood hypocoagulation and a tendency to bleeding will be indicated by:

• reduced prothrombin according to Quick (less than 75);
• decrease in prothrombin index (less than 80);
• increased prothrombin time (more than 18 seconds);
• increase in INR (more than 1.3).

Hypercoagulability and a tendency to form blood clots is characterized by:

• increased prothrombin index (more than 110);
• increased prothrombin (above 145);
• shortening of PV (less than 10 s);
• decrease in the INR index less than 0.8.

The main reasons for the decrease in prothrombin

Remember that prothrombin is a protein that is formed in liver cells with the participation of vitamin K. active state it passes with the help of several tissue and plasma factors clotting. The gene responsible for normal synthesis prothrombin, is recessive, and is located on chromosome 11.

In addition, there are also anticoagulant factors in the blood, increased activity which can inhibit the components of the prothrombin complex.

From this physiological mechanism and the main causes of low prothrombin and PTI follow (PT and INR are increased at the same time):

• Congenital pathology - changes in the genes responsible for the synthesis of prothrombin (rarely encountered).
• Liver diseases, accompanied by a decrease in the function or death of hepatocytes: chronic hepatitis, cirrhosis. The lack of structural units for synthesis leads to the fact that prothrombin in the blood is lowered.
• Vitamin K deficiency. This happens both with insufficient intake from food, and with a violation of its absorption and synthesis in the intestine. Therefore, diseases of the gastrointestinal tract, accompanied by dysbacteriosis and malabsorption of fats, can also lead to its deficiency.
• Decreased levels of V, VIII, X coagulation factors.
• Autoimmune diseases, accompanied, among other things, by the production of antibodies to prothrombin (more precisely, to the phosphatidylserine-prothrombin complex).
• Low fibrinogen level.
• 2nd phase of DIC (phase of exhaustion).
• Increased activity of the anticoagulant factor antithrombin III.
• Treatment with anticoagulants (heparin, fraxiparin, warfarin, neodicumarin).

Causes of increased prothrombin and PTI

An increase in PTI indicates hypercoagulability and is dangerous for the development of thrombosis (heart attacks, strokes, thrombosis of veins in the legs, thromboembolism pulmonary artery). This condition is especially unfavorable after operations and after childbirth.

• Last weeks of pregnancy.
• DIC - syndrome (stage 1).
• The use by women (and sometimes men) of estrogen-containing hormones.
• congenital thrombophilia.
• Too much vitamin K.
• Mutation of the prothrombin gene G20210A (carriers of the defective gene are 2-3% of the population).
• The period after heavy operations, burn disease.
• postpartum stage.
• Malignant tumors.
• Antithrombin III deficiency.
• antiphospholipid syndrome.

What to do with indicators that do not fit into the norm?

Prothrombin increased or decreased, what to do?

First, you need to see a doctor. Many people think that the answers to all questions can now be found on the Internet. In fact, this is far from the case. This is especially true of the coagulation system. The information presented on the net about this is very confusing and 50% is generally wrong. This indicates the high complexity of this issue.

Which doctor should I contact?

To the one who appointed the analysis. If you passed the coagulogram on your own, first we go to the therapist.

What must be said to the doctor?

• Be sure to list all medications that you are taking or have taken recently, including dietary supplements. Many drugs tend to affect coagulation parameters, and this applies not only to anticoagulants. So, may lower prothrombin Nevigramone, Streptomycin, Tetracycline, Levomycetin, L-thyroxine, vitamin A, Aspirin in high doses.

Increase PTI can: birth control hormonal preparations, caffeine, antihistamines, high doses of vitamins C, K, corticosteroid hormones.

• Long-term alcohol abuse can also reduce PTI.
• An excess of foods rich in vitamin K in the diet can lead to an increase in prothrombin, and their insufficient intake, on the contrary, to a decrease. These are foods such as greens, green vegetables and fruits, liver.
• Women should be sure to report their pregnancy.

What additional examinations can be prescribed?

• Liver function test (advanced biochemical analysis with the determination of bilirubin, hepatic transaminases, total protein, albumin).
• Ultrasound of the liver and biliary tract.
• Fibroelastography of the liver for suspected cirrhosis.
• Determination of antibodies to viral hepatitis.
• Advanced examination of the coagulation system (APTT, fibrinogen, thrombin time, D-dimers, plasminogen, antithrombin III, plasma fibrinolytic activity, lupus anticoagulant, etc.)
• Examination of the intestine (analysis of feces for dysbacteriosis, colonoscopy).

How to lower or increase the prothrombin index?

If the indicators are only slightly outside the normal range, do not panic. Perhaps some time after the cancellation of some medicines re-analysis will not reveal deviations. Many women are concerned about the question - what to do with the reception contraceptives? If diagnosed cardiovascular diseases- definitely stop taking it, if the woman is generally healthy, the pills can be taken, but the analysis should be periodically monitored.

You can also try adjusting the IPT with your diet if you are sure that your diet is clearly deficient in such foods as greens (parsley, dill, spinach), vegetables (cabbage, broccoli), beef or pork liver. Not bad increases PTI green tea.

At elevated level prothrombin and the risk of thrombosis, doctors usually prescribe anticoagulants. At the same time, only warfarin will clearly reduce this indicator. New generation anticoagulants (Pradax, Xarelto, Eliquis and others) act on other coagulation factors, while the level of prothrombin may not change.

Aspirin also does not change this indicator, but taking it in small doses makes sense to reduce the risk of blood clots.

When should you not spend time on a diet?

• If the coagulation parameters are significantly higher or lower than normal.
• There are symptoms of homeostasis disorders: recurrent bleeding or thrombosis.
• Presence of pregnancy.
• Abnormal coagulogram in a child.
• There are other symptoms (jaundice of the skin, dark urine, swelling, rash, pruritus and etc.)

In these cases, you need to full examination and find out the cause of the pathology of the coagulation system.